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NPI Code Detail

MEDICARE: JAMES BRIAN BODE APRN-BC

MEDICARE: JAMES BRIAN BODE APRN-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner970-033WI

General Provider Information

NPI Number : 1457373276
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES BRIAN BODE APRN-BC
Provider Business Mailing Address
First Line : 3301 W FOREST HOME AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53215-2843
Country : US
Telephone Number : 414-389-2377
Fax Number :
Provider Business Practice Location Address
First Line : 6901 W EDGERTON AVE
Second Line :
City : GREENFIELD
State : WI
Zip : 53220-4420
Country : US
Telephone Number : 414-325-5244
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2006
Last Update Date : 02/13/2020

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